Long-gap esophageal atresia: reconstruction preserving all portions of theesophagus by Scharli's technique

For distances of over 4-5 cm, esophageal replacement is almost always neces sary in esophageal atresias. We present the technical details and describe our experience with esophageal reconstruction by elongation of the lesser c urvature (Scharli's technique) in four cases of very long atresias. A retro sternal transposition was made without a thoracotomy in two children, and a n orthotopic mediastinal route through a right thoracotomy was done in two others. There were two main complications: anastomotic leaks in three patie nts that closed spontaneously, and too-rapid gastric emptying, resulting in dumping symptoms that improved with time and diet. One patient developed a n anastomotic stricture that responded to bouginage, while another had temp orary feeding problems. Esophageal reconstruction by elongation of the less er curvature provides a relatively simple method of esophageal replacement in children in that all portions of the esophagus are preserved. We propose this technique for early establishment of esophageal continuity in neonate s.